New results help please

[LV2475]

Hi there, I posted my results before Christmas when I was on 150mcg Levothyroxine and got some excellent advice here. I subsequently went gluten free and have been taking vitamins and supplements (D3, K2, B12, magnesium sulphate, Betaine HCl and digestive enzymes). I then persuaded my GP to increase Levothyroxine to 175mcg about 5 weeks ago.

My last results in December were:

TSH 4.26 (0.27-4.2)

T4 17.1 (12-22)

T3 4.0 (3.1-6.8)

TPO 535 (<34)

New results in photo.

My problem is I’m still really cold and tired. My brain fog got miles better after quitting gluten but that was before my thyroxine was increased. Clearly my GP will not increase Levothyroxine given these results and may want to decrease it. Any idea what else I can try? Or is it a matter of giving it a bit more time?

Thank you for having a look.

[SlowDragon Administrator]

Essential to test vitamin D, folate, ferritin and B12

Have these been tested?

Add results and ranges if you have them

Selenium supplements can help improve conversion of FT4 to FT3

What supplements do you currently take?

Do you always take same brand of Levothyroxine?

Do you always take Levo on empty stomach and then nothing apart from water for at least an hour after? Many take early morning, on waking, but it may be more convenient and possibly more effective taken at bedtime.

verywell.com/should-i-take-...

Other medication at least 2 hours away, some like HRT, iron, calcium, vitamin D or magnesium at least four hours away from Levothyroxine

Many people find Levothyroxine brands are not interchangeable.

Once you find a brand that suits you, best to make sure to only get that one at each prescription. Watch out for brand change when dose is increased or at repeat prescription.

Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

Is this how you did this test?

[LV2475]

Hi there. Thank you for your reply. Before Christmas my results were:

Vit D - 37 - that’s when I started Vit D spray (9000 iu/day) and K2.

Folate - 9.9 (>3.9ug/L)- just started folate supplement last week.

B12 - 337 (197-771 ng/L)- I started spray 2400mcg 1 month ago.

Ferritin 60 (13-150ug/L) - a bit scared to take iron as bowel movements aren’t great.

I take Levothyroxine in the middle of the night, supplements at least 4 hrs later. I don’t take any other prescribed medication. Forgot to say I’ve been taking Selenium 200mcg since mid December.

Brand wise...mixed currently - Activis 150mcg and Wockhardt 25mcg. Have been on loads of different ones.

I do tests as advised here - empty stomach, no Levo and early.

I think my T3 looks quite good now and my conversion ratio has improved a bit. Is it bad that my T4 is above range?

Thank you again.

[SlowDragon Administrator in reply to LV2475]

Eating liver or liver pate or other iron rich foods can help improve ferritin. Vitamin C can help improve iron absorption

Your vitamins will need retesting next time

Suggest you sit tight on current dose, see how it looks in another 2-3 months

If symptoms remain same, then look at getting appointment with pro T3 endocrinologist with view to reducing Levo slightly and adding small dose of T3

Email Dionne at Thyroid Uk for list of recommended thyroid specialists

[LV2475 in reply to SlowDragon]

Ok...thank you so much for your help SlowDragon - very much appreciated. I might get some desiccated liver capsules (to add to my collection) as I really can’t stomach liver. And I will get my vitamins checked again next time. 👍🏻